DENTAL CERAMICS PART 2

• GUIDED BY:
• DR.P.KARUNAKAR PRSENTED BY:
• DR.RAJI VIOLA SOLOMON DR.R.DEEPIKA
• DR.B.SRAVAN KUMAR
 Part 2:
• Non cast metal ceramic crowns
• All Ceramic Systems
o Conventional Powder And Slurry Systems
o Castable Ceramics
o Pressable Ceramics
o Infiltrated Ceramics
o Machinable Ceramics
o Laser sintering

• Extended & Innovative Applications Of Ceramics In Dentistry

• Conclusion
• References
Non cast metal ceramic systems
 THE FOIL CROWN SYSTEMS

Introduced by Dr. Itzhak Shoher and Aaron Whiteman in

Europe, and subsequently in North America after many years
of development.
Foil Crown Technology represents a novel approach by which a
metal ceramic crown can be produced in a relatively short time
without melting and casting the metal.

Types : Renaissance, Capatek, Ceplatec, Sunrise, Flexbond &

Platideck.
 Renaissance system

Steps in fabrication

• Initial adaptation

• Cutting the folds at the mid point.

• Folding pleats in same direction

• Burnishing the form for closer adaptation and trimming excess metal
• Die spacing using strips of plastic sheet

• Swaging

• Alloying

• Application of interfacial alloy

• Firing (at 1000°C) to produce a sintered alloy surface

 Captek system

• This system bonding to porcelain is achieved by the formation of an intermediate

layer of material such as Capbond metal-ceramic ‘bonder’ (bonding agent) for the
Captek foil crown system.

• Two strips of highly malleable metal powder impregnated ‘wax’ are adapted to a
refractory die.

• The first strip contains a gold, platinum and palladium alloy and the second is
impregnated with all-gold.

• 1075 C for 11mins

 Disadvantages of Foil Crown systems :

• Although fabrication is relatively easier, results comparing

strengths have reported that the strength of metal-ceramic
crowns was considerably higher than that of foil-based crowns
(about 30 to 80% of the metal-ceramic systems).
All ceramic
systems
• The term of “All ceramic” refers to any restorative
material composed excessively of ceramic, such as feldspathic
porcelain, glass ceramic, alumina core systems and certain
combination of these materials

-J. Esthetic Dent 1997, 9(2):86

 According to method of fabrication
- Rosenblum and Alan Schulman ,1997

1.Conventional Powder and slurry ceramics - : using condensing

& sintering.

 Alumina reinforced porcelain : Hi-ceram

 Magnesia reinforced porcelain : Magnesia cores.
 Leucite reinforced (high strength) : Optec HSP.
 Zirconia whisker – fibre reinforced : Mirage II.
 Low fusing ceramics
Hydrothermal LFC :Duceram
Finesse
• 2. Castable ceramics - Using casting & ceramming

 Fluoromicas –Dicor

 Apatite based glass ceramic -Cerapearl

 Other glass ceramic -Lithia based

- CaPO4 based
3. Machinable ceramics - : Milling machining by mechanical digital
control

• Analogous systems
1. Copy milling / grinding technique
Mechanical –Celay
Automatic –ceramatic II
2. Erosive techniques
Sono-erosion
Erosonic
Spark erosion -Procera

• Digital systems (CAD/CAM)

1. Direct -Cerec 1 and Cerec 2
2. Indirect -Cicero, Denti CAD, Automill
4.. Pressable ceramics
By pressure molding and sintering
1. Shrink free alumina reinforced ceramic
Cerestore/Alceram

2. Leucite reinforced ceramic

IPS empress
IPS empress 2
Optec OPC

5. Infiltrated ceramics - by slip-casting, sintering & glass infiltration

Alumina based - Inceram alumina
Spinel based - Inceram spinel
Zirconia based - Inceram zirconia
 Advantages Disadvantages
• Increased translucency
• Wear of opposing occluding
• Improved fluorescence
enamel or dentin
• Greater contribution of
color from the underlying
tooth structure • Difficulty in removing the
• Inertness crown and cementing
• Biocompatibility medium when replacement is
• Resistance to corrosion necessary
• Low temperature /
electrical conductivity
Conventional powder slurry ceramics
TYPES :

(a)Alumina reinforced Porcelain e.g.. : Hi-Ceram

(b) Magnesia reinforced Porcelain e.g.: Magnesia cores

(c) Leucite reinforced (High strength porcelain) e.g.. : Optec HSP

(d) Zirconia whisker – fiber reinforced e.g..:MirageI (Myron Int)

(e) Low fusing ceramics (LFC): (i) Hydrothermal LFC

e.g..: Duceram LFC

(ii)Finesse(Ceramco Inc
 LAB FABRICATION

• PLATINUM FOIL TECHNIQUE

• REFRACTORY DIE TECHNIQUE

PLATINUM FOIL TECHNIQUE
Die fabrication
Cut Pt foil so that Pt foil applied to the side of the
it may completely encircle die And held firmly
the die
0.75mm
Foil squeezed tightly at
joints with tweezer
Completed restoration
 ADVANTAGES DISADVANTAGES

• NO NEED OF • FOIL DISTORTION

REFRACTORY DIE POSSIBLE

• DIFFICULT TO
• EASY TO MEASURE
THICKNESS ASSESS ACTUAL
COLOUR
Refractory die technique
Refractory die pin
Advantage:
• Easier Technique

Disadvantage:

• Difficult to control veneer thickness require duplication of stone die

divestment is required.
Castable ceramics
 Glass-ceramics are polycrystalline materials developed for application by
casting procedures using the lost wax technique, hence referred to as “castable
ceramic ”

Castable dental Glass-Ceramics

 
 

Fluoromicas Apatite Glass-Ceramic OtherGlass-Ceramics

(SiO2K2MgOA12O3ZrO2 (CaOMgOP2O5SiO2 system) Based on a) Lithia

E.g Dicor E.g: Cera Pearl b) calcium phosphate

(Kyocera Bioceram)
 Dicor:
Dicor, the first commercially available castable glass-ceramic material for

dental use was developed by The Corning Glass Works .

heat - treated
cast as a glass
resulting in a
tetrasilicic mica vitreous (Glass or controlled produce a glass -
glass-ceramic lost-wax technique non- crystallization ceramic material
material crystalline/amorphou
using nucleating
s) state
agents
• Composition of Dicor
Major Ingredients
SiO2 45-70%, K2O upto 20%; MgO 13-
30%
 
MgF2 (nucleating agent & flux 4 to 9%)
Minor Ingredients
A12O3 upto 2% (durability &
hardness)
ZrO2 upto 7%; Fluorescing
agents (esthetics)
BaO 1 to 4% (radiopacity)
• Supplied as : Dicor castable ceramic cartridges- special DICOR casting
crucibles each containing a 4.1 gm DICOR ingot and the Dicor shading
porcelain kit.

• Equipment

Ø      DICOR Casting Machine

Ø      DICOR Ceramming Furnace with Ceramming Trays

CERAMMING TRAY CERAMMING FURNACE

DICOR casting machine DICOR ceramming furnace

with ceramming trays
Casting

• Glass liquefies at 1350°C to such as degree that it can be cast

into mold using lost wax and centrifugal casting technique
 Placed in a special zirconium crucible and
centrifugally cast in the electronically
controlled DICOR machine
• INVESTED

•Burned out in a conventional burn out at

900°C for 30minutes
 It is divested, sandblasted and carefully
separated from the spruce

The transparent glass casting obtained is

amorphous and fragile.
 Ceramming

 The glass is then covered by a protective embedment

material and subjected to a heat treatment that causes
microscopic plate like crystals of crystalline material (mica) to
grow within the glass matrix .

 This crystal nucleation and crystal growth process is called

ceramming
Ceramming cycle:

• 650 – 1075°C for 1 ½ hours and sustained

upto 6 hours following the ceramming
process, a ceram layer of 25 – 100 μm
thickness is formed on the surface of the
DICOR restorations

• According to the manufacturers laboratory

manual, the rod like crystals that form on
the surface of the casting during
ceramming increase opacity
Stains
or
veneering porcelain added
Properties

• High compressive , tensile strength and high modulus of elasticity

• Transparency
• Wear properties and co-efficient of thermal expansion closes to that of
dental enamel

• Decrease in plaque accumulation

• Interferes with bacterial adhesion to different proteins (Plaque) normally

found on natural teeth due to following reasons

 It has a smooth non porous surface

 Presence of an electrical charge inhibiting plaque
 formation or fluoride in the chemical structure
 Chameleon effect of Dicor

• Dicor ceramics is capable of producing surprisingly good

aesthetics, where part of the color of the restoration is
picked from the adjacent teeth as well as from the tinted
cements used for luting the restorations.

• Castable ceramics permits a one piece restoration made

entirely of the same material and no opaque substructure
exits to impede light scattering
 Advantages Disadvantages
• Ease of fabrication

• Improved aesthetics
• Used in low stress bearing areas

• Minimal processing shrinkage • Inability to be colored internally

• Good marginal fit

• Moderately high flexural strength

• Low thermal expansion

• Minimal abrasiveness to opposing

tooth
Two veneering materials were used to improve the color of dicor
crowns

• Dicor plus - consists of a cast cerammed core and shaded

feldspathic porcelain veneer however, as Dicor plus is a
feldspathic porcelain that contains leucite, the abrasiveness is
similar to other feldspathic porcelain.

• Willis Glass : Consists of a Dicor cast cerammed core and a

Vitadur-N porcelain veneer similar in nature to that used for
Dicor Plus.
Castable Apatite Glass Ceramic

Cera Pearl

• Contains a glass powder distributed in a vitreous or non

crystalline state.

Composition

• CaO – 45%
• Phosphorous – 15%. Aids in glass formation
• Magnesium oxide – 5% -Decreases the viscosity
• Silicon dioxide – 35% - forms the glass matrix
• Other trace elements – nucleating agents
 Chemistry of cerapearl

1460 C Exposure To Moisture

• CaPO4 oxyapaptite hydroxyapatite

Amorphous Crystalline Ceramming crystalline

 Fabrication include
casting
ceramming

Desirable characteristics of Apatite Ceramics:

• Cerapearl is similar to natural enamel in composition, density,

refractive index, thermal conductivity, coefficient of thermal
expansion and hardness.

• Similarity in hardness prevents wear of opposing enamel.

Bonding to tooth structure

• Glass ionomer cements adhere to tooth structure (dentin and enamel)

primarily bonding to the apatite component, and thus should also bond to the
apatite phase within the glass-ceramic.

• To enhance this possibility, Cerapearl surface (etching of with 2N HCI

preferentially removes the glassy phase from the surface, thus exposing the
apatite phase).

• The glass ionomer can then bond to this apatite phase both chemically (ion-
exchange) and mechanically (interlocking effect).
Lithia based glass ceramic
• Developed by Urgu
• Composition : It contains mica crystals and crystals of LiO, A12O3.4SiO2
after heat treatment.

Calcium phosphate glass ceramic

• Reported by Kihara and others

• Combination of calcium phosphate and phosphorus pentoxide plus
trace elements.
• Cast at 1050°C in gypsum investment mold .
• Clear cast crown is converted to a crystalline ceramic by heat
treating at 645°C for 12 hours
Disadvantages

• Weaker than other castable ceramics

• Opacity reduces the indication for use in anterior teeth

Pressable ceramics
 PRESSABLE CERAMICS

Shrink-free Ceramics Leucite-reinforced

Glass-ceramics
Cerestore
Al-Ceram
Pressed –Heat transfer-molded glass ceramics.

IPS Empress & IPS Empress 2 (Ivoclar)

Optec Pressable Ceramic / OPC
(Jeneric/Pentron)

Non-Pressed-
Optec HSP & Optec VP (Jeneric / Pentron)
Fortress (Mirage
CERESTORE Non-Shrink Alumina Ceramic is a shrink-free ceramic with
crystallized magnesium alumina spinel fabricated by the injection molded
technique to form a dispersion strengthened core.

Composition Of Shrink Free Ceramic  

 

Unfired Composition Fired Composition (Core)

 

A12O3 (small particles) 43% A12O3 (Corundum) 60%

A12O3 (large particle) 17% MgA12O4 (Spinel) 22%
MgO 9% BaMg2A13(Barium Osomilite)
Glass frit 13% 10%
Kaolin Clay 4%
Silicon resin (Binder) 12%
Calcium Stearate 1%
Sterylamide 1%
Advantages
Disadvantages
• Dimensionally stable •Complexity of the fabrication process

• Accuracy of fit and marginal

integrity •Need for specialized laboratory
• Esthetic equipment and high cost

• Biocompatible and resistant to

plaque formation •Inadequate flexural strength

• Radiodensity similar to that of

enamel •Poor abrasion resistance
• Low thermal conductivity

• Low coefficient of thermal

expansion and high modulus of
elasticity
 IPS EMPRESS
 Pre-cerammed, precoloured leucite reinforced glass ceramic formed from the
leucite system by controlled surface crystallization, subsequent process stages
and heat treatment.

 First described by Wohlwend and Scharer

 Glass contains latent nucleating agents and controlled crystallization

 Partially pre-cerammed product of leucite reinforced ceramic powder

available in different shades is pressed into ingots and sintered, and then
injected into the investment mold.
Composition (Wt. %)
• SiO2 – 63%
• Al2O3 – 17.7%
• K2O – 112%
• Na2O – 4.6%
• B2O3 – 0.6%
• CeO2 – 0.4%
• CaO – 1.6%
• BaO – 1.6%
• TiO2 – 0.2%

A special furnace empress EP 500

   Conventional Dicor Glass- IPS Empress
Leucite Porcelain ceramic Pressable ceramic
concentration

30-35% 50-60% 80-85%

Advantages
Disadvantages
• Lack of metal or an opaque ceramic
core • Potential to fracture in posterior
• Moderate flexural strength (120- 180
MPa) areas
• Excellent fit • Need for special laboratory
• Improved esthetics
equipment
• Etchable
• Less susceptible to fatigue and stress • Relatively translucent crowns
failure
• Difficulty in retrieval of crowns
• Less abrasive to opposing tooth
• Biocompatible material • Lower compressive strength and
• Does not require ceramming
flexural strength
OPTEC (Optimal pressable ceramic / OPC)
-         Feldpathic porcelain with increased leucite content
-         Increased flexural strength
-         Abrasion against natural teeth is higher
-         Fabrication similar to IPS Empress
-         Flexural strength – upto 150 MPa
 
IPS empress 2
·  Made from lithium disilicate framework with an apatite layered
ceramic
·  Glass ceramic ingots made from lithium silicate glass crystals with
crystal content of more than 60 volume %
· The apatite crystals incorporated are responsible for the improved
optical properties, chameleon effect of leucite glass ceramic
materials
• Flexural strength – 400Mpa
     
IPS Empress IPS Empress 2 (frame work)
 

     
Flexural strength Upto 150 MPa > 400 Mpa
 

Advantages
•  High biocompatibility
• Excellent fracture resistance, High radiopacity
• Outstanding translucency
 Fabrication:
wax pattern
invested in a
special flask

using IPS Empress

special investment
material (phosphate
bonded).

Following burnout (at

850°C) the crucible The ceramic ingot of
former is placed into the the selected dentinal
base of a specialized shade is placed under
automated furnace (EP the plunger
500 Press furnace)
 is preheated
to 1,1000C

(0.3-0.4 MPa) into the

mold, in which it is held
temperature reaches under pneumatic
11500C after a 20 pressure (for a 45-
minute holding time minute period) to allow
the plunger presses the complete and accurate
ceramic under vacuum fill of the mold
Infiltrated ceramics
 In-Ceram Alumina
 
In – Ceram In – Ceram Spinell
 
In – Ceram Zirconia

Developed by a French scientist and dentist Dr. Micheal

Sadorun (1980)
 Involves three basic steps

Making an with
infiltrated intensely denseto core
molten glass yield aby slip
ceramic
infiltrated corecoping
is veneered with
casting
feldspathic porcelain
 Slip casting :

• A slip is a suspension of fine insoluble particles in a liquid .

• Slip casting is the art or science of preparing stable suspensions

and forming ware by building up a solid layer on the surface of a
porous mold that sucks up the liquid phase by means of capillary
forces (Kingery 1958)
 Tooth preparation done

Dental stone dies fabricated,

Spacer applied.
 Impression of working
model taken

Refractory die made (In-

Ceram Special Plaster, Vita
Zahnfabrik)
 Slip cast material
applied to die (special
plaster model made of
porous refractory matrix

Sintered in ceramic oven

1100 degree C for 10 hours special
furnace (In-Ceramat, Vita Zahnfabrik)
 Refractory die
shrinks away
from inceram

0.3% sintering shrinkage

 Glass – infiltration :

• A specially formulated low-fusing glass-infiltrate

(lanthanum glass) powder of appropriate shade and matching
thermal expansion is mixed with distilled water.

• The frameworks are set on a platinum-gold foil (Pt-95; Au-

5) and the glass-water slurry is amply applied (to avoid air
impactions) over the external surface of the porous
substructure.
• This infiltration firing with glass not only confers the selected shade
to the core, it also increases the strength of the core to about 20
times its original strength and flexural strength of upto 446 Mpa
have been reported.
Infusion glass infused to coping
(1120 degree C) over 4-5 hour period.)
Excess glass is removed by sandblasting (35-50um corundum for 3-
6 hrs.) and grinding with diamond stones.

• Another firing (10 mins at 960°C) is necessary to check for excess

glass, which would have to be removed by blasting
Inceram coping
 Veneered with
feldspathic porcelain

Final restoration
• Final firing is followed by adjustments and glazing of external
surface.

• The internal surface is sandblasted (with 50 A12O3) since the

density of In-Ceram core makes conventional methods of etching
with HF acid ineffective for bonding with a resin-cement (eg:
Panavia 21 TC).
Advantage :

1.Minimal firing shrinkage, hence an accurate fit.

2. High flexure strengths (almost 3 times of ordinary porcelain) makes the

material suitable even for multiple-unit bridges.

3. Aluminous core being opaque can be used to cover darkened teeth or post/
core.

4. Wear of opposing teeth is lesser than with conventional porcelains.

  
5. Improved esthetics due to lack of metal as substructure.

6. Biocompatible, diminished plaque accumulation, biochemical stability.

Disadvantages :

Ø      complex technique, Requires specialized equipment to fabricate the

restoration, hence laboratory expense is more.

Ø      Poor optical properties or esthetics (opaque alumina core reduces the
translucency of the final restoration).

Ø      Incapability of being etched with HF acid,

Ø      Requires considerable reduction of tooth surface all over for adequate
thickness of restoration.
 Procera (Sandvick)

 It Has Alumina Content More Than 99.9% (Flexural Strength Upto 650
Mpa) Has Been Used. In :
 Ceramic Core For Single Tooth Replacement (Cera One, Branemark
System, Nobel Biocare)
 Ceramic Abutment For Implant Supported Single Crowns (Ceradapt,
Branemark System, Nobel Biocare).
Machinable ceramics
 MACHINING SYSTEMS

CAD/CAM (Digital) COPYING SYSTEMS (Analogous)

Direct Indirect Copy Milling Erosion

Cerec 1 Automill, Manual Automatic Sono- Spark –

DCS- erosion erosion
  President,
Cicero,
& Denta,

    Celay Ceramatic DFE DFE

Cerec 2 Denti CAD, II DCP Erosoni Procera
Sopha – c
Bioconcept
 Machinable Ceramic system (MCS) for
dental restorations:
   

      Analogous systems (Copying methods)

Copy Milling / Copy Grinding or Pantography Systems

Two steps :

§         Fabrication of prototype for scanning;

§         Copying and reproducing by milling

Digital Systems (CAD/CAM):

 Direct

 Indirect
 

Three steps :

§         3-dimensional surface scanning

§         CAD -Modelling of the restoration

§         Fabrication of restoration.

ANALOGOUS SYSTEMS (COPYING / PANTOGRAPHY METHODS )

Copy milling

a replica of
fabrication of a
inlay / crown is
prototype (pro-
made and fixed an
inlay or crown)
in the copying improvement
usually via
device and over
impression
transferred 1: 1 conventional
making and
into the chosen ceramics
model
material such
preparation.
as ceramic.
 Fractured central incisor restored with copy-milled all-ceramic
post and core.

Esthetic Rehabilitation of Anterior Teeth with Copy-Milled

Restorations: A Report of Two Cases Case Reports in Dentistry
Volume 2017 
 Sono erosion –

 Based on ultrasonic methods.

 Both sonotrodes fitting exactly together in the equational plane of the intended
restoration are guided onto a ceramic blank after connecting to an ultrasonic
generator, under slight pressure.

 The ceramic blank is surrounded by an abrasive suspension of hard particles,

such as boron carbide, which are accelerated by ultrasonics, and thus erode the
restoration out of the ceramic blank.
 Spark Erosion:

 Refers to 'Electrical Discharge Machining' (EDM) which was used by the tool
and die industry during the 1940's and was adapted into dentistry in 1982.
 It may be defined as a metal removal process using a series of sparks to erode
material from a workpiece in a liquid medium under carefully controlled
conditions.
 The liquid medium usually, is a light oil called the dielectric fluid.
 It functions as an insulator, a conductor and a coolant and flushes away the
particles of metal generated by the sparks.
 Digitized
technologies

subtractive additive
manufacturing manufacturing
(SM),assisted by (AM) assisted by
cad-cam cad-cam

Structural and morphological approach of Co-Cr dental alloys processed by

alternative manufacturing technologies .
Sorin Porojana , Mihaela Bîrdeanub , Cristina Savencuc , Liliana Porojanc
IOP Conf. Series: Journal of Physics: Conf. Series 885 (2017) 012005
Applications of CAD CAM

French
system

Minnesota
Swiss system
system
 IMPRESSION
Data acquisition
CONTACT
CAMERA LASER DIGITIZER
CASTS & DIE
Restoration
Design
WAX PATTERN COMPUTERIZED
DESIGN
Restoration
fabrication

INVEST
MACHINE ELECTRICAL SINTER
DISCHARGE
MACHINE
CAST
Digital systems
Cerec 1 System
acronym for chair side economic reconstruction of
esthetic ceramic
• 3 D video camera (Scan head)
• An electronic image processor (Video processor)
with memory unit (Contour memory)
• A digital processor
• A miniature milling machine (3 axis machine)
Preparation Covered With Opaque Powder(Titanium
Dioxide )
Intraoral Camera To Take Optical Impression Of
The Preparation
 Cerec 2 system

• Developed by Morman and

Brandestini - 1994

Major changes
• Enlargement of the grinding unit
from 3 axis to 6 axis
• Upgrading of the software with more
sophisticated technology which
allows machining of the occlusal
surface
Other technical innovation of Cercec 2

• Improved Cerec 2 Camera - new design, easy to handle

detachable cover, reduction in the pixel size / picture element

to improve accuracy and reduce errors

• Data representation in the image memory and processing

increased by 8 times, while computing capacity is 6 times

more efficient
• Magnification factor increased X8 to X12
• Visual control of video image –better

• Permits custom veneer preparation and class IV preparation

with incisal edge coverage

• Improved in rigidity and grinding precision by 24 times

• Improved accuracy of fit

 Ceramic blocks

Cerec Vitablock mark

[10-50 um ]

Cerec Vitablock mark 2

• Feldspathic porcelain reinforced with
Aluminium oxide [4 um]

Dicor MGC
fluoromica crystals in a glass matrix
2 um
 Clinical advantages of the Cerec system

•Quality controlled ceramic porcelain can be placed in one visit

•Translucency and color of porcelain very closely appearance the
natural dental hard fissures
•Qualities of ceramic porcelain do not change by variation
•Wear resistant
 CEREC 3
Simplifies & accelerates the fabrication of ceramic inlays, onlays,
veneers,& quarter, half,& complete crowns for anterior& posterior
restoration
• Proper occlusion is established accurately& quickly
• Manual adjustment is reduced to minimum
• Network &multimedia ready& combination with an intraoral
color video camera
• Can be used with existing PC and the Cerec 2
  Cylindrical floor bur &conical
occlusal milling bur

 Flexible shaping technique

 Better adapted to tooth preparation

 Replicate the occlusal morphology

better

 More economical
 Lava CAD/CAM System2
 Introduced in 2002
 fabrication of zirconia framework for all ceramic restorations.

Lava system uses a

laser optical system

Lava CAD software

automatically finds the
margin and suggests a
pontic.

CAM produces an
enlarged framework to
compensate shrinkage

. A partially sintered
ziroconia block is
selected for milling

Milled framework
undergoes sintering to
attain final dimensions,
density and strength.
 DCS Precident

Comprises of a Preciscan laser Scanner and Precimill

CAM multitool milling center

DCS software automatically suggests, connector

sizes and pontic forms for bridges

one of the few systems that can mill titanium

and fully dense sintered
zirconia.

in vitro study showed that marginal discrepancies of alumina and ziroconia based
posterior fixed partial denture machined by the DCSsystem was between 60 µm to
70µm 7
 INDIRECT METHOD

Cicero system

computer integrated crown Reconstruction-Introduced by Denison et al in 1999,

Developed for the production of ceramic fused to metal restorations

• Optical scanning
• Metal and ceramic sintering
• Computer aided crown fabrication techniques

The unique feature of this system is that it produces crowns, FPD’s and
inlays with different layers such as metal and dentin and incisal
porcelains
 Procera All Ceram

Introduced in 1994, it is the first system which provided

outsourced fabrication using a network connection.

3-D images is transferred through an internet link to processing

enlargement compensates for sintering shrinkage

coping is sent back to the lab for porcelain veneering.

marginal gap for Procera all Ceram restoration

ranges from 54 µm to 64 µm
 Selective laser sintering

Selective laser melting (SLM) is a new additive manufacture

technology that can be used for fabricating complex metallic
products.

 Selective laser melting machine was first introduced by

Fockele and Schwarze (F&S) of Germany in 1999 .

 In 2008-09 new version of SLM was released by MTT

named SLM 250 and SLM 125.
Journal of Asian Ceramic Societies
Volume 1, Issue 4, December 2013, Pages 315-321
open access. panelBinQianZhijianShen
 Mechanism of action

This technology works by selectively sintering fine powder

materials directly using an infrared (IR) laser from CAD.

The SLM molding process is a rapid melting and rapid

solidification process.

When a high-energy laser beam acts as a heat source on the

surface of the metal powder, the material undergoes rapid
melting and rapid solidification in a very short period of
time.

The laser acts on the metal surface to form a molten pool.

 Selective laser melting is a process of additive
manufacturing from point—line, from line—face, and
from face—body.
 The parts are formed by layers of molten pool, so the
shape and continuity of the pool determines the final
performance of the part.

Fabricating High-Quality 3D-Printed Alloys for Dental Applications

Min-Ho Hong 1 , Bong Ki Min 2 and Tea-Yub Kwon 1,3.
Appl. Sci. 2017, 7, 710; doi:10.3390/app7070710
Processing strategies for the selective laser melting substructure of dental metal-ceramic
restoration (left) and schematic representation of different types of molten pool boundaries
(MPBs)(right): (a) single MPB; (b) “layer-layer” MPB; and (c) “track-track” MPB.
Figure 2. Processing strategies for the selective laser melting substructure of dental metal-
ceramic restoration (left) and schematic representation of different types of molten pool
boundaries (MPBs) (right): (a) single MPB; (b) “layer-layer” MPB; and (c) “track-track” MPB.
Laser power 160 W, scanning speed 1100 mm/s, and scan line
spacing 0.05 mm.

The scan line spacing is the distance between two adjacent

laser scanning trajectories directly affects the forming quality
of each layer scanning
pitch is too small-, the secondary remelting tends to form a
coarse grain structure.
If the scanning pitch is too large, generates a large number of
voids, thereby reducing the density.
 selective laser
sintering in ceramics

direct SLS (dSLS) indirect SLS (iSLS)

 INDIRECT SLS

The dry The laser The laser

ceramic powder or scanning melts scanning melts Finally, the
powder is slurry is then the polymer the polymer resulting
binder, ’glueing’ binder, ’glueing’ ceramic part
mixed with a deposited the ceramic the ceramic
polymer and laser particles particles is sintered
binder scanned together in the together in the In furnance
layer by layer process process.
 DIRECT SLS

interaction of
ceramic particles the laser with
Afterwards no
are deposited the ceramic
no polymer de-binding or
and laser particles will
binder is used furnace sintering
scanned layer by cause the
is required.
layer particles to bind
together

Direct selective laser sintering/melting of high density alumina powder layers

at elevated temperatures J. Deckersa , S. Meyersa,∗ , J.P. Krutha , J.
Vleugelsb
Physics Procedia 56 ( 2014 ) 117 – 124
 Nd:YAG fiber laser, , can be focused in a spot ten
times smaller than that of the continuous wave
CO2 laser.
 Therefore, the CO2 laser is less suitable for laser
sintering of ceramics through the melt-solidification
mechanism, but is applicable for sintering ceramics
through the solid or liquid state sintering
mechanisms.
Common Restorative Materials for Dental
CAD/CAM Systems
Processing Sintered Cast/ Hot/ Pressed Sintered and CAD/CAM
method Cerammed Glass
infiltrated

Acid etchable etchable etchable etchable Not indicated etchable

Abrasiveness Moderately Minimally Moderately highly Minimally to

of core high
ceramic

Easy of Easy Easy Easy Difficult Easy to

cutting difficult

Treatment Two visits Two visits Two visits Two visits one visits
time

Draw backs Weak and No products Leucite All, but spinel Requires a
unsuitable as are available reniforced type tend to uniform light-
a core for full not indicated look to reflecting
ceramic or for FPDs opaque if powder to
FPDs tooth deposit
reduction is
inadequate
Processing Sintered Cast/ Hot/ Pressed Sintered and CAD/CAM
method Cerammed Glass
infiltrated

Type of MC C C C C
construction

Margin Poor margins Good Good to Fair to Good Fair to Good

Quality Excellent

Appearance Opaque Translucent Slightly Opaque Slightly

translucent translucent to
translucent

Relative Weak weak Moderately Moderately Moderately

strength strong to very strong strong

Relative Low Low Moderately Moderately Low to high

toughness high high to high
Bonding to porcelain
• The bonding of resins and ceramics introduced new restorative techniques .

For the bonding between porcelain (inorganic substrate) and composite resin
(organic substrate) the silane primer is essential.

• In order for the silane primer to function the porcelain must have some hydroxy1
(-OH) groups available on the surface.

composite resin
porcelain

the silane primer

• Porcelain contains silica (SiO2) as a major ingrediant in addition to other alkaline
oxides. Water is absorbed on the porcelain surface resulting in hydroxy1 (-OH)
gruops to which some water molecule hydrogen bond.

• Because of this hydroscopic nature, the porcelain can absorb relatively thick
films of water upon standing and this water layer could become strongly alkaline.

• Acidifying the porcelain surface not only helps wash away the above –
mentioned alkaine layer of absorbed water to achieve a higher degree of
silanization, it also enhances surface roughness (microscopic etching) to obtain
optimal bond to the luting agent.
Etching of Ceramic surface:

• In 1981 – Perelmuter and Montagnon proposed etching of

ceramic with 7.5 to 10% Hydrofluoric acid (HF) for 2 to
10mins.

• silanization should follow etching to increase the bond strength

of ceramics.

• Etching results in a surface that looks slightly frosty and is

microscopically roughened compared with the relatively
smooth surface of unetched porcelain
 Acid etching of ceramic is indicated for following reasons-

• To wash away the alkaline layer of absorbed water on the

porcelain surface.

• To increase the surface tension and develop surface

characteristics that can be maximally wetted by the resin
adhesive.

• To selectively etch the surface so as to increase surface area for

micromechanical bonding between both substrates (tooth and
ceramic) and resin adhesive.
 Porcelain Etchant Etching
  Time

  i)9 to 12% (9.5%) HF(e.g.:Ceram 2-4 mins

Feldspathic Etch/Porcelain Etch
porcelain  
 
 
ii)1.23% APF Upto 10
  mins
 

Dicor & Dicor 10% Ammonium bifluroide gel 1.5 mins

MGC (e.g.: Dicor Etching Gel (L.D Caluk)

Cera Pearl 2 N HCI  

 Precautions while using ceramic etchants:

• Use Rubber gloves and protective glasses while handling.

• Avoid skin contact and spilling on surfaces (as the ammonium bifluoride gel is
highly corrosive). The etchant may be applied directly from the bottle with a
disposable brush.

• HF is potentially harmful to both hard and soft tissues; hence, for intra-oral use
it should only be used under strict isolation of a rubber dam (or 1.23% APF may
be used)

• Use with adequate ventilation and avoid prolonged or repeated breathing of

vapor and its contact with skin
 Silanization

silane coating of an etched

glass surface

bond to the silica crystals in the glass

matrix through the ethoxy-, chloro-or
amino-

groups leaving the vinyl group to react and

form a bond with the resin.

The silane treated glass, with its

methacrylate groups can then form a bond
with the methacrylate groups in the resin

Different parts of the silane

molecule are capable of bonding
 Ceramic Bonding Systems

• Consists of a silane primer and a resin adhensive.

• Silane primers can be categorized as :

1.Unhydrolyzed single liquid silane primer,

2.Prehydrolyzed silane primer that is also a single liquid,

3.Two or Three –liquid primer with separate silane

coupler and acid activator.
 Various silane coupling agents available in the
market

• 3M Scotchbond Ceramic Primer (3M Dental Products, St. Paul)

• Clearfil Porcelain Bond (J.Mortia Co, Trustin CA)

• Caluk Silane Coupling Agent

 
• Porcelite(Kerr Mfg Co)
 REPAIR OF CERAMIC RESTORATIONS

Porcelain Repair : Fracture is totally in porcelain (Simplest repair)

 Fractured porcelain fragment When missing

  Fractured porcelain fragment When available

Mixed (Porcelain/ Metal) repair – involves exposed metal (More
complicated).

Remaining porcelain:

 If adequate to retain composite - Exposed metal and

remaining porcelain is veneered with composite opaquer
and subsequently with layers of shade matched composite
(after preparation of both porcelain and metal surface for
repair by bonding).

 If inadequate to retain composite - Exposed metal surface is

used as an adhesive substrate after preparation, for bonding
with composite opaquer layer followed by shade matched
composite
Metal repair: involves exposed metal with minimal or no porcelain (most
difficult).
 
Two methods:

 Veneering exposed metal surface with direct bonding of shade matched

composite after preparation of exposed metal surface for bonding.

 Fabrication of an overcasting: Small areas of remaining porcelain are

removed if present.
 A thin metal overcasting with a fused porcelain veneer is fabricated.
 EXTENDED & INNOVATIVE APPLICATIONS OF
CERAMICS IN DENTISTRY

• Posterior esthetic restorations (Inlay & Onlays)

• All-Ceramic Post & Core systems (Zirconia ceramics)
• In Dental Implants
• Ceramic coating for dental implants
• Implant supported ceramic restorations
• Bioactive ceramics
• Ceramic Orthodontic Brackets
• As fillers
• Glass-ceramic inserts for composite resins,
• Glass ionomer cements
• Investments
• Gingival toned ceramics
• Ceromers (ceramic optimized polymer)
• Polymer rigid inorganic matrix material(PRIMM)
• Fiberkor
Criteria for selection and use of dental ceramics

• Dentist should not use all ceramic crowns for patients with
evidence of bruxism, clenching or malocclusion. – metal
ceramic / all metal prosthesis

• The experience of laboratory technician should be extensive

to ensure of success rate of at-least 97% over 3 years

• A metal ceramic crown made from metal ceramic systems

with which one had previous clinical success is preferred
over all ceramic crown when the patient has average
appreciation of aesthetics
• Use all ceramic crowns when adjacent teeth exhibit high
degree of translucency .

• Patients must accept the described benefits , risks, and

alternatives to the postponed treatment, and they must give
their informed consent .

• The skill of the dentist is of paramount importance in

producing perfect impressions derived from smooth
preparations free of undercuts with continuous, well defined
margins and with adequate tooth reduction
Case reports:

Ceramic onlay
Veneers
veneers
Comparative Analysis of Mechanical Properties and Metal-Ceramic Bond
Strength of Co-Cr Dental Alloy Fabricated by Different Manufacturing
Processes
Xingting Han 1,†, Tomofumi Sawada 1,2,† , Christine Schille 1 , Ernst Schweizer 1 , Lutz Scheideler 1 ,
Jürgen Geis-Gerstorfer 1 , Frank Rupp 1 and Sebastian Spintzyk 1,* Materials 2018, 11, 1801;
doi:10.3390/ma11101801

• The Co-Cr alloy specimens manufactured by the SLM technique have

enhanced mechanical properties and comparable metal-ceramic bond
strength compared with the specimens prepared by the casting and
milling techniques;
• 2. The microstructure of the Co-Cr alloy depends on the manufacturing
techniques. Compared with casting and milling, the SLM specimens
have relatively homogeneously distributed fine grains and more
dispersed second-phase particles;
Bond strengths of porcelain to cobalt-chromium alloys made by casting,
 
milling, and selective laser melting .
Li J1, Chen C2, Liao J3, Liu L3, Ye X3, Lin S3, Ye J
J Prosthet Dent. 2017 Jul;118(1):69-75

• study was to evaluate the metal-ceramic bond strength of a Co-

Cr alloy made by casting, milling, and selective laser melting (SLM).
• milling- and SLM-produced alloys had better porcelain adherence.
 Conclusion

• The aim of restorative and esthetic dentistry is to restore the

decayed or missing part of the teeth with a bio-compatible material
that matches natural enamel in appearance and physical
characteristics and maintain occlusal anatomy to promote proper
oral function.

• Dental ceramic technology is one of the fastest growing areas of

dental material research and development.
• Considerable advances in the field of dental ceramics has
brought forth novel processing technologies which have
enhanced the properties and clinical acceptability of these
materials.

• Each system has its own merits, but may also have
shortcomings. Combinations of materials and techniques are
beginning to emerge which aim to exploit the best features of
each.
 References

• Philips science of dental materials{10th and 11th edition}

• Esthetics of anterior fixed prosthodontics: chiche/Pinault
• Esthetic dentistry: Dale Aschheim
• Fundamentals of esthetics: Claude R Rufenacht Rosenblum M.A., Schulman A.
: A review of All-Ceramic Restorations. JADA, 128: 1997; 297-307.
• Anusavice K.J. : Recent Developments in Restorative Dental Ceramics. JADA
124: 1993; 72-84.
• Mormann W.H. and Bindl A. : The Cerec 3-A quantum leap for computer-
aided restorations: initial clinical results. Quintessence Int. 31: 2000; 699-712.
• Seghi R.R., Denry I.L. and Rosensteil S.F. : Relative fracture toughness and
hardness of the new dental ceramics. J. P.D. 74: 1995; 145-150.
• The dental Clinics of North America. Ceramics, 1985, 29:4.
• Anusavice K.J. : Phillip’s Science of Dental Materials. 11th edition.
• Sikri V.K. : Textbook for operative Dentistry, C.B.S. Publication and
distributors, New Delhi, India.
• Qualtrough A.J.E. and Piddock V. :Recent advances in ceramic
materials and systems for dental restorations. Dental Update
1999; 65-72.
• Qualtrough A.J.E. and Piddock V.: Ceramics Update. J. Dent.
Res. 1997; 25(2): 91-95.
• Christensen G.J.: A state of the art in esthetic restorative
dentistry. JADA 128: 1997; 1315-1317.